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APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date issued /Zn-j�---------- Ik is hereby made to the San Joaquin Local Health District fh9r a permit to construct and install the work herein described. Application Y This application is made in compliance with County Ordinance �� , �} 1----------------------------- - I C:y` JOB ADDRESS AND LOCATION-p.. ----- -------- --------------- Phone---- --- --- --------- - ----- Owner's Name------------------------ ------------- - ----- �" �, - � � r --------------------------------------- Address__ r F Address--------------------•--------- - ------ Phone--------•-----------•------------ ----------------------------------------------- - -- Contractor's -- Other Name_---------•-----••------------------------- - •-- •-- - -- , artment House ❑ Commercial ❑ Trailer Court ❑ M to Installation will serve: Residence p -- _----------- --__ Number. of edrooms - __ Number of baths _�--,-- Lot size ------- -- -- -- � Number of living units: �_ _ Sys tem ❑ Private El Depth to Water Table -------- f+• Water Supply: Public system ommunit YGa Adobe Hardpan Q ravel Sandy Loam ay Loam El ❑ Character of soil to a depth of 3 feet: Sand ❑ -. ❑ ❑ Clf ��,e"wConstruction: Yes o ❑ Previous Application Made: Yes F1No's '� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if p blit sewer is available within 240 feet.) Material_ f Distan rom Efoun tion__ -- Ca acit Se tic Tank: Distance from nearest well__ . Liuid �8p�------- p y_t No. of compartments-____ � ----- Size-- ----- q �_______-Distance to nearest lot 4ine_ !-_.---- --- Distance from foundation_____ r'r E Length of each liner"- a-- � " idth of trench__-____ Disposal Field: Distance from nearest well, .. Number of lines______ • th of filter material___-_--�-` ---_ ----Total length-------.---�-�•�+---- �---_"- Type of filter material-----rf--- ___ "Dep ___-__-Distance from #oundation_______-__--.__---Distance to nearest lot line__._.-;--• -- Seepage Pit: Distance to nearest well_______________ - -------------Size: Diameter-----------------------.Dept -------------------------------- ❑ Number of pits----------------------Lining material__-____-_ Distance #rom nearest well_________________Distance from foundation_._-_____------- ---Lining material------------------------------------- Distance ____---__-_------ --- -gals. 1 Cesspool: - -------Liqutd Capacity----------------- ----------g ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------- 171 ------------------------------------------ - Distance from nearest well-------------------------------------------------- ------------------------------------- ------Distance from nearest building------------------------------------------ Privy- -------------•--------------------- - - Privy: ------------------------- --•-------------------- Distance to nearest lot line---------------------------"---- - ---------------------- ❑ -----------•----------------- Remodeling and/or repairing (describe):------------------ -- ----------------------_--------------- •------------------ ---------------•------------•--------------------•-- ----- -- --------------------------------------•------------------- ` I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances; State laws, and rules and regulations of the an Joaquin Local Health District. (Owner and/or Contractor) (Signed) --------- - ------------------(Title)--- ----------------------------- ------ -------------------- By:---------------------------------------------- ---- --- --i ------- ------------ (Plot plan, showing size of lot, location of system m rel a#ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ! _ ---- -- --------------- DATE-------- - ---- --- APPLICATION ACCEPTED ------------- ----- - - ----- ------ - DATE----------------------------------------------- REVIEWED ------- -------- --------------------- --------- REVIEWEDBY--------------------------------- --------------------------------------------�----------------------------- DATE.----------------------------------------------------------- ------- t' _ c `_ :c' t' .- •�--------=----------------------------------------- BUILDING PERMIT ISSUED--------------------------------------- t-- Alterations and/or recommendations:__-----.- --- "= `---- - ----- ------ -------- ------------ - -- --------- •------------------------------------ Date---------------•---- FINAL INSPECTION BY:---- ------ ----- SAN JOAQUIN LOCAL.HEALTH DISTRICT gl4 North "C" Street 132 Sycamore Street 300 West Oak Street Tracy, California 130 South American Street Manteca, California Stockton, California Lodi, California ES-9-2M 8-51 Revised W-2100 t -